Abstract P258: Racial Disparity in 90-Day Post-Stroke Readmission - An MUSC Perspective

Abstract

Background: Readmissions after acute hospitalizations are a cause of both risk and expense, and many of them are potentially preventable. Importantly, risk-standardized hospital readmission rates are sometimes used as a yardstick of the quality of care offered. However, racial variability in readmissions might involve factors beyond quality of care and has not been studied extensively. Objective: To identify differences in readmissions between African Americans and other races and determine preventable readmissions from a pragmatic viewpoint. Methods: We obtained deidentified data from Medical University of South Carolina (MUSC) Electronic Data Warehouse (EDW) on adult admissions with index diagnosis considered as an ischemic stroke (or closely related) using International Classification of Diseases, Ninth Revision (ICD-9) codes 433.x, 434.x, 436.x, 437.x between January 2011 and June 2014. Of these, we determined readmission and reason for readmission over 90-day period. Readmission can be hospital or emergency room readmission. We obtained race as the only linked demographic. Results: Of the 1953 patients admitted with index diagnoses of stroke, 765 (39%), 1148 (59%) and 50 (1%) were African Americans, Caucasians and others, respectively. At 90-days, 256 patients were readmitted as in-patient, of which 128 (50%), 126 (49%) and 2 (1%) were African Americans, Caucasians and others, respectively. On the other hand, 241 patients visited Emergency Room, of which 175 (73%), 65 (26%) and 1 (1%) were African Americans, Caucasians and others, respectively. On adjusting readmissions to index admissions, 17%, 11% and 4% of African Americans, Caucasians and others, respectively, were readmitted in hospital, while 23%, 6% and 2% of African Americans, Caucasians and others, respectively, visited Emergency Room over 90-days period. Conclusions: 90-days readmission rates involve African Americans in a disproportionate manner. This demands further investigation on the etiology of readmission and the care offered.